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Modification of pulmonary endarterectomy to prevent neurologic adverse events

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Abstract

Purpose

Neurologic adverse events (NAEs) are a major complication after pulmonary endarterectomy (PEA) performed under periods of deep hypothermic circulatory arrest (HCA) for chronic thromboembolic pulmonary hypertension. We modified the PEA strategy to prevent NAEs and evaluated the effectiveness of these modifications.

Methods

We reviewed the surgical outcomes of 87 patients divided into the following three groups based on the surgical strategy used: group S (n = 49), periods of deep HCA with alpha-stat strategy; group M1 (n = 19), deep HCA with modifications of slower cooling and rewarming rates and the pH–stat strategy for cooling: and group M2 (n = 13), multiple short periods of moderate HCA.

Results

PEA provided significant improvement of pulmonary hemodynamics in each group. Sixteen (29%) of the 49 group S patients suffered NAEs, associated with total circulatory arrest time (cutoff, 57 min) and Jamieson type I disease. The Group M1 and M2 patients did not suffer NAEs, although the group M1 patients had prolonged cardiopulmonary bypass (CPB) and more frequent respiratory failure.

Conclusions

NAEs were common after PEA performed under periods of deep HCA. The modified surgical strategy could decrease the risk of NAEs but increase the risk of respiratory failure. Multiple short periods of moderate HCA may be useful for patients at risk of NAEs.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan

    Keiichi Ishida, Hiroki Kohno, Kaoru Matsuura, Michiko Watanabe, Masahisa Masuda & Goro Matsumiya

  2. Department of Respirology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba, 260-8677, Japan

    Toshihiko Sugiura, Takayuki Jujo Sanada, Akira Naito, Ayako Shigeta, Rika Suda, Ayumi Sekine, Seiichiro Sakao, Nobuhiro Tanabe & Koichiro Tatsumi

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  1. Keiichi Ishida
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Correspondence to Keiichi Ishida.

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Ishida, K., Kohno, H., Matsuura, K. et al. Modification of pulmonary endarterectomy to prevent neurologic adverse events. Surg Today 53, 369–378 (2023). https://doi.org/10.1007/s00595-022-02573-w

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